Abstract: Poster Presentations |

Interventional Bronchoscopy in the Treatment of Tracheal Obstruction Due to Thyroid Cancer FREE TO VIEW

Alessandro Ribechini, MD; Valeria Bottici, MD; Antonio Chella, MD; Rossella Elisei, MD; Paolo Vitti, MD; Aldo Pinchera, MD; Nicolino Ambrosino, MD*
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Cardio-Thoracic Department. Pulmonary Unit, Pisa, Italy


Chest. 2004;126(4_MeetingAbstracts):819S. doi:10.1378/chest.126.4_MeetingAbstracts.819S-b
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PURPOSE:  Surgery is the treatment of choice of symptomatic tracheal obstruction due to malignant thyroid disease. Few additional therapeutic alternatives are available: Radiotherapy (RT), chemotherapy (CT) or radio-iodine therapy (131-I). Only few studies on interventional bronchoscopic procedures (IBP) as alternative procedures are reported so far. This study is a retrospective report of results of IBP performed in patients with severe tracheal obstruction due to thyroid cancer.

METHODS:  Since 1/1/2000 to 31/3/2004 14 consecutive patients (5 males, mean age: 62.2 yrs) underwent IBP due to tracheal obstruction for anaplastic (ATC : 7 patients), differentiated (DTC : 5), medullary (MTC : 1) and non epithelial malignant (NEMN: 1) thyroid cancer. 8/14 had local advanced inoperable disease ab initio, 6/14 had local relapse after surgery, 131-I or RT. Ten patients out of 14 were submitted to IB for severe dyspnoea. In 4 patients airways patency was maintained by insertion of a stent; in 3 the tracheal neoplasm was removed by Nd-YAG laser, in 7 both procedures were performed.

RESULTS:  All 10 patients with dyspnoea showed an improvement of symptom. Early and late complications were observed in 4 and in 3 patients respectively. All but 4 DTC patients died 11.9 ± 14.2 months after the diagnosis (4.20 ± 5.1 after IB). In 4 DTC patients still alive at follow up, 90.7 + 59.2 months since diagnosis and 16.7 + 9.2 since IB; the airways dilatations allowed following treatment like 131-I and/or RT.

CONCLUSION:  Interventional bronchoscopy, including Nd-YAG laser and airways stenting are alternatives to surgery in inoperable thyroid –induced tracheal obstruction. Moreover, the airway dilatation improve the dyspnea and allowed successive treatment.

CLINICAL IMPLICATIONS:  Interventional bronchoscopy should be considered as an option in the comprehensive treatment of thyroid cancer.

DISCLOSURE:  N. Ambrosino, None.

Wednesday, October 27, 2004

12:30 PM - 2:00 PM




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